Provider Demographics
NPI:1689961328
Name:FELLS, GABRIEL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:FELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GLENWOOD AVENUE
Mailing Address - Street 2:APT. 26 C
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:804-305-5970
Mailing Address - Fax:
Practice Address - Street 1:508 AIRPORT EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10958
Practice Address - Country:US
Practice Address - Phone:845-425-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY617027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse